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Analysis concludes city should keep ambulance service

The city of Ashland would not financially or operationally benefit from eliminating Ashland Fire & Rescue’s ambulance service, a recent analysis by Public Consulting Group found.

Ashland City Council reviewed the ambulance transporting services cost and service analysis at its June 14 study session. The Cost Review Ad Hoc Committee recommended the study in May 2020, as city department budgets tightened in response to the economic fallout of the pandemic.

Public Consulting Group reviewed national firefighting and emergency medical service standards, budget, volume of calls for service, and five years of AFR expenditures and revenues in its audit. The city paid for the analysis with contingency dollars in the general fund, at a total cost of $48,720, according to council documents.

“The decision to discontinue the ambulance service will affect not only the residents in the city of Ashland, but also residents in areas surrounding Ashland,” according to Public Consulting Group’s report. “[The analysis] clearly indicates that the ambulance transport is an enhancement, not a detriment, for the city.”

Stakeholders and contributors on the analysis included representatives from the city, International Association of Fire Fighters Local 1269, AFR, Jackson County Fire District No. 3, Andres Medical and Reinholdt & O’Harra Insurance.

Jackson County Fire District No. 5 was not listed as a contributor on the study, but remains a strong operational partner with AFR, said City Manager pro tem Adam Hanks. The consulting team had a prior professional relationship with District 3 Chief Robert Horton, and the fire district’s new Community Care Program is of interest to city leadership, hence their selection as a regional contributor, he said.

City Council will have 12 to 18 months to review information and decide whether to renew a five-year license with Jackson County, or go another route with the ambulance service, Hanks said.

As of 2015, the city’s Insurance Service Office rating — indicating a fire department’s capability to defend its community — was Class 3, with Class 1 being the best possible rating. The city received a 50% deduction in points for inadequate staffing. The classification influences property insurance rates in the community.

Excluding supplemental staff provided by partners, AFR’s nine on-duty personnel structure falls short of standards established by the National Fire Protection Association, which requires at least 18 personnel respond to a low energy structure fire, based on response time and emergency management objectives.

A review of AFR’s “critically understaffed” department today or any further reductions in staff may drop the city’s score to Class 5, the report said. Low staffing reduces firefighter safety and increases hazard mitigation time and the potential for civilian casualties.

AFR recently obtained approval to fill three firefighter positions — left vacant in response to the COVID-19 pandemic in 2020 — leaving the department still lacking four to five personnel to align with NFPA standards after filling the slots.

Public Consulting Group project specialist Charley Hurley said across the U.S., volunteer firefighter programs have proven unable to overcome recruitment and retention challenges that impede success with the format. Volunteer firefighters still incur costs for specialized equipment and thousands of hours of training required for certification, he said.

“As a fire chief, for every one position I have, I have to have four volunteer firefighters to fill one position to get me a FTE equivalent,” Hurley said.

In fiscal year 2019, AFR expended just over $10 million. Ambulance transports, transfers, fees and the ambulance membership program bring in $1.3 million annually, which is distributed among programs and services supported by the general fund and does not go directly back into AFR’s budget.

Transports generated from 911 calls represent the department’s largest revenue stream — about 93% of total ambulance-related revenue.

Combined direct and indirect costs to operate the ambulance service total nearly $2.3 million. Factoring in revenues, the average annual net cost to maintain the ambulance service alone is $840,900, according to the analysis. The figure represents the true amount of general fund dollars leveraged to maintain the ambulance service.

“Although this may seem as an advocacy piece, the compelling factors here are the staffing that you have, how that staffing impacts the insurance rates within the community for both businesses and for residents — it’s also the $1.3 million in revenue that the ambulance transport brings into the city,” Hurley said. “The loss of any of those is going to have an operational, administrative and fiscal negative impact to the city. We looked at this as objectively as we possibly could, but the conclusions are the conclusions.”

Public Consulting Group recommended the city consider expanding the ambulance service area to include Phoenix as a revenue-generating tactic, among other recommendations, such as updating the department's mission statement to make clear whether ambulance services are part of EMS delivery, and improving the ambulance membership program.

According to Ken Riddle, senior advisor for fire and emergency medical services at Public Consulting Group, the city could save money within the fire department by implementing community risk reduction programs to reduce overall call volume.

A drastic increase in wildfire-related expenses was reported in 2017, accompanied by the highest documented unit response and transport volume for the department. By the 2019 fiscal year, wildfire-related expenses totaled nearly $2 million, compared to $274,693 in fiscal year 2016.

Together, AFR’s ambulances are worth about $175,000 in resale. PCG cautioned the city against considering eliminating the ambulance service as a source of savings, without factoring in extra costs incurred from moving staff to engine companies only and other factors.

Privatizing the ambulance service was projected to cost more than an extra half-million per year. Maintaining a local ambulance service supports patient continuity of care, the report said, which can improve patient health outcomes.

“A conversation that we had during the cost-cut committee was in fact that maybe Mercy Flights would consider putting their ambulances in our fire department,” said Councilor Shaun Moran, urging the council to continue considering opportunities for third-party partnership.

With existing capacity, AFR can respond to up to four concurrent incidents at once — without ambulance transport, capacity to respond to multiple incident locations drops by half, according to the report.

“I know that it saves lives,” Councilor Stefani Seffinger said regarding personal emergency experiences with the ambulance service. “I know that we would be risking providing the same level of care to our community if we didn’t have the service that we have.”

Ashland’s ambulance service may make the city an attractive partner in future emergency operations regionalization efforts, Seffinger said.

Contact Ashland Tidings reporter Allayana Darrow at adarrow@rosebudmedia.com or 541-776-4497.